Wisconsinis back in the national spotlight with numerous public policy choices enacted that affect healthcare for women and girls in the Badger State.

One of the most controversial – SB 206/Act 37 – was signed into law a few days ago on July 5, 2013 making Wisconsin is the 9th state in the nation to require a woman to receive an ultrasound prior to receiving an abortion. However U.S. District Judge William M. Conley citing a “troubling lack of justification” has issued a “stay” until July 18 for the “admission provision” of Act 37 which is likely to cause at least two clinic closures in the state.

Budget cuts are also affecting healthcare for women and girls. We were on hand in May as the Chippewa Falls Planned Parenthood closed its health care center after serving thousands of patients since 1984. Over 400 patients will be displaced, explained a small group of women. We interviewed Nicole Safar and supporter Carol Gahl about the 4 clinic closures around Wisconsin, including Beaver Dam, Shawano and Johnson Creek. Collectively, these clinics serve 2700 patients, 2/3 of whom are below the poverty line. Safar tells us that none of the closing clinics provide abortion services, a reason often used to justify funding cuts. Rather, each of the 4 closing clinics provide care to mostly low-income women, including cervical and breast cancer screenings, birth control, annual exams, STD testing and treatment, and pregnancy and HIV testing.

Gahl explained, “The fact is, to most women Planned Parenthood means birth control, not abortion…and it is sad that some people have to go to such extremes to close clinics.”

Here’s their story.

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Nicole Safar, Planned Parenthood Public Policy Representative, standing next to the closing sign. State budget cuts forced the closure of this Chippewa Falls health clinic on May 17, 2013.

Q. Why are PP clinics closing around the state of Wisconsin?

A. “In 2011, the state budget ended state funding for Planned Parenthood. For over 3 decades we’ve had been a partnership with the state of Wisconsin providing reproductive health services for patients across the state receiving about a million dollars every year to provide that a care. That left 9 of our health centers across the state without access to these state funds and unfortunately, fast forward to now in 2013 and we are not able to sustain the services at 4 of those clinics.

The budget consequences are not always immediate. Sometimes it takes a while and we are experiencing that right now

But Planned Parenthood has a really strong commitment to our patients and the state of WI. We’ve been here for 78 years and that‘s what we really want people to know – we’re not going anywhere. Our commitment to this community is strong and we know that women and men who don’t have access to health insurance need a place to get basic services.”

Q. You speak about men, but I suspect most people don’t think about men going to Planned Parenthood.

A. “Yeah, so Planned Parenthood of Wisconsin serves a little over 70,000 patients in the state and about 8% are men. Men are an important piece of the public health puzzle. Women can’t be healthy if their partners aren’t healthy. We do offer the same types of services – STD testing and treatment, birth control counseling, condoms, basic wellness for men as well.”

Q. Where are the displaced patients going to go for health care?

A. “In all of our closing, we’ve been working with patients to help transition them. So for instance here in Chippewa Falls, the closest clinic is Eau Claire [about 14 miles]. The closing in Shawano caused more issues where the closest PP is Green Bay [about 38 miles].

[This can be a problem] certainly, because 2/3 of our patients live below the federal poverty level. That is $11,000/year for a single person…so transportation is a problem. Any time you get out of the urban areas in WI, we all know that there is no public transportation. Unless they have a car, there’s no investment by our state in helping people get to the care they need.

It’s a huge, huge problem that we need to address as a state and as a community and figure out not only how to keep community health centers open, but how to get people to the places to access care.”

Q. In your experience, how else has public policy choices affected the patients you serve?

A. “In general, public policy is so important for public health…both funding wise and making sure people have a place to go. But also making sure there aren’t any rules creating barriers to access to birth control.

[For example] there is a really important health policy that was past in 2009 called “Expedited Partner Therapy’. It allows us to dispense an extra dose of antibiotics for the partner of a patient who tests positive for an STD. We try to get the partner to come in first obviously, but that isn’t always going to happen.

You see, the public health community has been saying for years that the best thing to do would be to give an extra dose of the antibiotics so that the partner could just bring it home. But WI pharmacy rules made that impossible until we were able to change the policy and it has really helped us address the skyrocketing Chlamydia rates, for example. I mean, if you are treated for an STD and your partner isn’t…you are re-infected! [shrugs shoulders and laughs]

So, yes… you need to treat both partners. So the “Expedited Partner Therapy” is an excellent public health policy that helps us do that. SO that is an example of a true every day impact of that public policy can have.

But, I think in general what we’ve seen since Governor Walker came into office in 2011 and the state legislature switched so drastically to very extreme Republicans, we’ve seen women’s health especially take so many hits…and really been used as a political football by passing really restrictive laws at both restriction to access to birth control and defunding, but also aimed at abortion access.

Planned Parenthood provides abortion services at 3 of our health centers – Madison, Milwaukee, and Appleton. And there is only one other abortion clinic in our state. So there are only 4 abortion clinics in the state and Planned Parenthood runs 3 of them. Women who live here (West central Wisconsin) have no options. Minneapolis is probably the closest option for women in this part of the state.”

Q. So you said that women’s health care has taken “many hits”. Would you tease that out a bit?

A. “Sure. So, last legislative session we saw defunding as I’ve said. But we also saw deep cuts to the BadgerCare program as well. The vast majority of the people on BadgerCare are women and many of them are moms. So this is the Planned Parenthood demographic – right? You know, the women of child-bearing age.

The state passed a law that would prohibit insurance companies from covering abortions. That law is a little tricky because it is related to the federal law that was passed – the Affordable Care Act. If you are going to be buying a health insurance plan under the Affordable Care Act in WI, it won’t be allowed to cover abortion services.”

Q. You mentioned the federal Affordable Care Act (“ACA” or ObamaCare) – how does that legislation impact Planned Parenthood and your patients?

A. “We thought the ACA would actually counteract a lot more of the bad policy…I mean, but I also don’t think it is an overstatement to say that it is still the greatest move forward for women’s health in a generation.

For instance, birth control, pap tests, STD screening, and preventative care is available without a co-pay if you have insurance.

It allowed states to expand their Medicaid programs for their reproductive health care.

It also ends gender discrimination in pricing. So for instance, right now women are often times charged 5 – 10 times more than a man for the same health care plan. So insurance companies won’t be able to do that anymore under the ACA

Also insurance comps won’t be able to treat a C-section, an abnormal pap test, or a use of domestic violence services as a pre-existing condition.”

Q. Wait a minute – being the victim of domestic abuse can cause denial of health insurance?

[smirking and nodding head] “Yeah. So the ACA prevents insurance companies from doing that anymore. So it really has many great protections for women overall, right? It really is an incredible federal law…but most of the ACA doesn’t go into effect until 2014. “

Q. So it is clear that Planned Parenthood serves women. But more broadly speaking how do you serve families and communities?

A. “Great question. Planned Parenthood serves community overall by making sure men and women both have access to public health services health, have access to prevention….Chlamydia rates have gone down, unintended pregnancy rates have gone down, and we have an education dept that works mostly with parents and some school based programs too.

A huge community service we provide is by offering a professional training component – we teach nurses, teachers and counselors at churches about how to talk to teens about sex and sex education.

And we also provide advocacy. There really isn’t another group that gives a voice to women’s equality and women’s access to health care in the state. Planned Parenthood is able to provide a state-wide voice and resource and speak out and talk about why access to birth control is important and why abortion should remain a safe, legal option.”

Q. You’ve mentioned abortion a couple of times. There is a significant portion of the population that disagrees with the choice of abortion. Do you think that fact makes Planned Parenthood susceptible to budget cuts?

A. “Well…I’m going to push back on that premise a little bit. Our polling, both in WI and nationally, shows consistently that 65-75% of people believe that abortion should remain safe and legal.

Now if you are going to ask people if they are ‘pro-life’ or ‘pro-choice’ you are going to get about 50/50.

But what we’ve really found as we’ve tried to get more sophisticated in our research is that people may identify one way or another, but it doesn’t always translate directly to their feelings about access to abortion.

It doesn’t mean the same thing that it meant 30 yrs ago…especially for people under the age of 30. That type of thing doesn’t matter to them at all…young people believe that if people want that option they should be able to have it.

So certainly the fact that we provide the full range of women’s health care means that we put a certain target on ourselves.

Yet 98% of what we do is prevention. Only 2% of what we do is abortion services. I do end up talking about it a lot because it is the ‘hot button’ political issue. But at Planned Parenthood our mission is to make sure that women and families have children when they are ready to have them. And we work really hard to make sure that happens.”

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Carol Gahl, Chippewa Falls, WI resident; Long-time involvement with Planned Parenthood includes work as a nurse, board member, and mother of patients.

Q. What does this clinic closing mean to you?

A. “One of the first things I remember about Planned Parenthood is when I used the mom and daughter ‘sex ed’ services. [We were able to] talk about growing up and sex in a really relaxed and easy way. We had a professional there with us and we could just talk about what they needed to know. One of the best ways to talk to my daughters was when I was driving the car and they could ask something. If they were a little embarrassed they still did it.

I think it is really sad that any type of clinic has to close. Anyone in Chippewa Falls who needs to go to Planned Parenthood now has to find a way to get to Eau Claire. It’s a shame that people who don’t like Planned Parenthood have to go to the extreme to try to close clinics.”

Q. So it sounds like you used Planned Parenthood to help educate your daughters. That’s not the typical scenario most people get when they think of a mother taking her daughters to Planned Parenthood. They might assume abortion services.

A. “To me, Planned Parenthood is the one operating group that prevents abortions more than anybody else. I don’t care how many billboards somebody puts up if they aren’t offering the solutions. Planned Parenthood is right there to help people get the things they need…like medicine or breast exams, pap smears, SDT checks, birth control…

The truth is that things have changed and not many options are available if you are a student and you have parents who really don’t want you to have sex education. Planned Parenthood is the only answer. Most girls in college use Planned Parenthood because they didn’t want to get pregnant – so that is what Planned Parenthood is all about to them.

I think that people who don’t like Planned Parenthood always throw up the abortion issue first. But what I can tell you is that they probably don’t know is that their daughters are probably going to Planned Parenthood! [laughter erupts in the small group of women attending the interview, nodding in agreement]. In my head, I have names – and I would never give them out – that is private and no one needs to know – but some of the loudest [opposition] have daughters that go here.

The point is this – to most women Planned Parenthood means birth control, not abortion. In fact, women go to Planned Parenthood to make sure they never have to have to consider an abortion!”

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With health clinics closing and patients flooding into the remaining clinics around the state, I decided to call the Eau Claire Planned Parenthood to ask about setting up an appointment as a new patient. There was a 6-week wait for the next appointment – much longer than the few days I’ve grown accustomed to with adequate health insurance. Now with the displacement of 2700 patients in the state, many of whom will flood to the fewer remaining clinics (if they have the means), many patients may expect even longer wait times. Transportation is likely to prevent some from receiving continuing health care – including the birth control pill, the most popular form of contraception for women. As Gahl asserts “to most women Planned Parenthood means birth control, not abortion.”

Thousands of women may now need to look elsewhere for their daily medication.

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